Reimagining the Dental Team: Hygienists as key to reconnecting underserved patients with the dentist’s office

As a dental hygienist, I used to work in a clinic, helping treat dental disease and educate patients about their oral health. I enjoyed it, but I knew I was only seeing a fraction of the population. Where I work, in rural Oregon, many mothers, children, and pregnant women just don’t get to the dentist until they have developed serious dental problems that damage their overall health. Now, however, we don't wait for those patients to come to us—we go out and find them.

In 2015, my employer, Advantage Dental, the largest provider of Medicaid services in the state, decided to reform its care delivery system to focus on health disparities. Because Oregon allows hygienists who hold an Expanded Practice Permit to perform certain dental services with remote supervision, Advantage has reimagined team-based dentistry. The company deploys expanded practice dental hygienists (EPDHs) like me to reach patients who wouldn’t otherwise get to a dentist soon, and we bring those patients into the dental care system.

My EPDH colleagues and I go out into schools, WIC clinics, Head Start programs, and anywhere we find mothers and children who might need dental services. We examine patients for changes in their teeth or other problems, and based on their oral health, provide other low-complexity treatments they need—such as applying silver diamine fluoride, which halts the bacterial infection causing cavities. We then help connect them with a dentist or clinic with the help of case managers. My job is very different now, and I’m thriving on the new responsibility.

To make this community-based approach work, we act as a team—the EPDHs in the field, our case managers, our regional managers who deploy us to the needed locations and cultivate relationships with community organizations, and the staff at the dental offices and clinics. We set goals for care and screening that have to be met in each county, and every month we review the data on our progress. We also receive a bonus in pay if the team meets its care and screening targets, but what motivates me the most is the numbers. I’m a competitive person; seeing those numbers go up as we reach each metric makes me work even harder and try to help the rest of the team solve problems. For example, I can support case management if they are having difficulty making an appointment with a family. The likelihood that I’m going to run into that family again in the community is great, and they are more likely to trust the person sitting in front of them more than someone over the phone.

I can't tell you how rewarding it is to make a difference like this. Just recently I saw a young girl who had the worst case of tooth decay I'd ever seen. It was affecting her health and immune system, and she was underweight, probably because it hurt to eat. Because I was able to identify her and connect her with our clinics, she got the care she needed instead of being stuck in a downward health spiral that could have led to chronic health issues and emergency room visits.

There are other community-based oral health programs, but I’m not aware of any that go as far as this one to connect patients with dentists. If the patient has a dentist, we inform the dentist that the patient was seen, and if they need more care than we can deliver right then and there, we ensure they get to an office or clinic for the needed treatment. We have an electronic system called ADIN that keeps everyone on the team up to date and makes sure our case managers know with whom to follow up.

Our approach strengthens ties with the community and with community organizations that serve the most vulnerable mothers and children. Together, we create more comprehensive services and educate people about how to be healthy. In so doing, we hope to end the scourge of tooth decay in these communities.

This program, called PREDICT, is just a start. The Robert Wood Johnson Foundation’s Finding Answers program and the University of Washington are helping us work out the details over time and share our learnings with other providers and payers. Soon, we plan to expand PREDICT across our whole service area—and we hope others will follow our lead. When given the opportunity, hygienists can make a big difference in delivering care to those who need it most.

Ashley Danielson is a Regional Community Expanded Practice Dental Hygienist working with Advantage Dental in Oregon. She provides oral health assessments and preventive services based on risk to children via school-based programs for grades K-12. She performs similar services at WIC, Head Start, OCDC, The Next Door, and medical clinics. She has been with Advantage Dental since 2012, and worked full time in a community outreach role since 2015. She enjoys educating people about oral health and building relationships with patients and families.